Clinical Frailty Scale at Presentation to the Emergency Department: Interrater Reliability and Use of Electronic Decision Support

Abstract

Purpose: The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, in order to support clinical decision making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the IRR of CFS ratings comparing assessments by ED clinicians and a study team supported by a smartphone application for CFS assessment, and to determine the proportion of patients aged 65 or older who were assigned a CFS level in our ED in routine clinical care.Methods: Prospective study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707).Results: We included 1,348 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (ϰ=0.73, 95% CI: 0.69–0.76), similarly to that between TC and geriED-TN (ϰ=0.75, 95% CI: 0.66–0.82) and between the ST and geriED-TN (ϰ=0.74, 95% CI: 0.63–0.81). A CFS rating was assigned to 972 (70.2%) patients at triage.Conclusion: We found good IRR in the assessment of frailty with the CFS in different ED providers and a team of medical students using a smartphone application to support rating. A CFS assessment occurred in more than two thirds (70.2%) of patients at triage.